Early Recognition of Pediatric Strokes in the Emergency Department: Epidemiology, Clinical Presentation, and Factors Impeding Stroke Diagnosis in Children

Si Qi Tan(Si Qi Tan),Wen Qi Cher(Wen Qi Cher),Shu-Ling Chong(Shu-Ling Chong),Angelina Su Yin Ang(Angelina Su Yin Ang ),Sashikumar Ganapathy(Sashikumar Ganapathy ),Derrick Wei Shih Chan(Derrick Wei Shi 대한소아신경학회 2022 대한소아신경학회지 Vol.31 No.1

Purpose: Strokes are challenging to diagnose in pediatric emergency departments (EDs) as level of suspicion is low and atypical presentations are common. We analyzed clinical features, epidemiology and factors of delayed identification in arterial ischemic strokes (AIS) and hemorrhagic strokes (HS). Methods: Single-center retrospective cohort study of children aged between 29 days and 18 years old diagnosed with stroke between July 2016 to June 2021. Results: Among 36 children, 11 (30.5%) had AIS, 25 (69.4%) had HS. Median age for AIS was 9 years (interquartile range [IQR], 2 to 9) and HS 9 years (IQR, 1 to 11.5) (P=0.715). Focal neurological deficit was seen in 72.7% of AIS and 20% of HS (P=0.006). Only 18.2% of AIS and 52.0% of HS presented within 6 hours of symptoms. Median time from symptom onset to ED presentation was 24 hours (IQR, 12 to 28) for AIS and 7 hours (IQR, 1.8 to 48) for HS (P=0.595). Most (85.6%) arrived by own transport. Median time from presentation to neuroimaging was 7 hours (IQR, 0.9 to 7) for AIS and 4.8 (IQR, 1.3 to 16.8) hours for HS (P=0.376). Eleven patients, 9/25 (36.0%) HS and 2/11 (18.2%) AIS, did not have stroke as differential diagnosis at ED (P=0.714). Common initial diagnoses were viral illness or headaches. On univariate analysis, age <1 (odds ratio [OR], 17.5; 95% confidence interval [CI], 1.2 to 250.4; P=0.035) and absence of focal neurological deficit (OR, 13.091; 95% CI, 1.5 to 117.9; P=0.022) were significant factors for delayed identification. Conclusion: Index of suspicion for pediatric strokes among caregivers and clinicians should be increased. Public awareness campaigns are recommended.

Atypical Ductal Hyperplasia of the Breast on Core Needle Biopsy: Risk of Malignant Upgrade on Surgical Excision

Tiffany Sin Hui Bong,Jun Kiat Thaddaeus Tan,Juliana Teng Swan Ho,Puay Hoon Tan,Wing Sze Lau,Tuan Meng Tan,Jill Su Lin Wong,Veronique Kiak Mien Tan,Benita Kiat Tee Tan,Preetha Madhukumar,Wei Sean Yong 한국유방암학회 2022 Journal of breast cancer Vol.25 No.1

Purpose This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making. Methods This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010–2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination. Results Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound (p = 0.018) or mammography (p = 0.026), microcalcifications (p = 0.047), diffuse microcalcification distribution (p = 0.034), mammographic parenchymal density (p = 0.008). and ≥ 3 separate ADH foci found on biopsy (p = 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005–0.35; p = 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21–25.2; p = 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831–1.920; p = 0.002) remained significant in multivariate analysis and were included in the nomogram. Conclusion Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74–0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.

An Improved PSO Algorithm Based on SA and Quantum Theory and Its Application

Wei Tan,Shoubin Dong,Xuan Liu,Bin Wang 보안공학연구지원센터 2015 International Journal of Database Theory and Appli Vol.8 No.6

Due to the low computational precision, local optimal solution and slow convergence speed of particle swarm optimization (PSO) algorithm, an improved PSO (SAQPSO) algorithm based on simulated annealing (SA) and quantum theory is proposed in this paper. The first, quantum theory is used to change the updating mode of the particles in order to improve the search speed and the convergence precision, and guarantee the simplification and effectiveness. Then the SA with probability and local search ability is introduced into quantum PSO (QPSO) in order to keep the diversity of the population, avoid falling into local optimum and enhance the global search ability. The SAQPSO algorithm keeps the characteristics of the simple and easy implementation, improves the global optimization ability and the convergence speed and the accuracy. Finally, some benchmark functions are used to prove the validity of the proposed SAQPSO algorithm. The computational results show that the proposed SAQPSO algorithm takes on the fast convergence speed, the better robustness and global search ability.

Demographic characteristics and intravenous drug use among hepatitis C patients in the Kota Setar district, Kedah, Malaysia

Wei Leong Tan,Goh Yihui,Muhammad Radzi Abu Hassan 한국역학회 2015 Epidemiology and Health Vol.37 No.-

OBJECTIVES: This study explored the demographic characteristics of hepatitis C patients in the Kota Setar (KS) district, Kedah, Malaysia, the prevalence of intravenous drug use (IVDU) as a risk factor among these patients, and the associations between IVDU and demographic characteristics. METHODS: Retrospective data pertaining to 713 patients from January 2009 to December 2013 were retrieved from hospital and disease notification records for analysis. The risk factors for hepatitis C virus (HCV) infection were grouped into IVDU and non-IVDU risk factors for analysis using multiple logistic regression. RESULTS: Of the hepatitis C patients included in this study, the most common age group was 31 to 40 years (30.2%), and male patients (91.2%) made up the overwhelming majority. Ethnic Malays constituted approximately 80.4% of the patients, and IVDU was the main risk factor (77.8%) for HCV infection. Multiple logistic regression showed that male patients were 59 times more likely to have IVDU as a risk factor for HCV infection. Single patients were 2.5 times more likely to have IVDU as a risk factor. Patients aged ≥71 years were much less likely than patients aged ≤30 years to have IVDU as a risk factor for HCV infection. CONCLUSIONS: IVDU was found to be an important risk factor for HCV infection among patients in the KS district. The factors associated with IVDU included age, sex, and marital status. Appropriate preventive measures should be developed to target the groups in which IVDU is most likely to be a risk factor for HCV infection.

Technical Note : The FasT-Fix Repair Technique for Ramp Lesion of the Medial Meniscus

( Wei Ping Li ),( Zhong Chen ),( Bin Song ),( Rui Yang ),( Wei Quan Tan ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.1

Introduction: This technical note describes a new arthroscopic technique to repair the peripheral attachment lesion of the posterior horn of the medial meniscus. The operation was performed under arthroscopy using a standard anterior portal. Surgical Technique: A FasT-Fix needle was inserted obliquely close to the tibial plateau and the first implant was inserted into the joint capsule depending on its bending angle underneath the meniscus. The second implant was inserted through 1/3 periphery of the meniscus into the meniscocapsular area. The pre-tied self-sliding knot was tensioned to achieve secure fixation of the posterior meniscal peripheral attachment at the original attachment point. Materials and Methods: From August 2011 to February 2014, 23 knees were diagnosed as ramp lesion, underwent meniscal repair using FasT-Fix technique. Results: All patients were followed up for average 14 months. The Lysholm score improved from preoperative 64.4±4.52 to postoperative 91.2±4.60. Conclusions: We believe that the FasT-Fix technique via the standard anterior portal can be a more convenient and less traumatic alternative for repair of the peripheral attachment lesion of the posterior horn of the medial meniscus in the anterior cruciate ligament deficient knee.

Radiation-induced Cochlea Hair Cell Death: Mechanisms and Protection

Tan, Pei-Xin,Du, Sha-Sha,Ren, Chen,Yao, Qi-Wei,Yuan, Ya-Wei Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.10

Cochlea hair cell death is regarded to be responsible for the radiation-induced sensorineural hearing loss (SNHL), which is one of the principal complications of radiotherapy (RT) for head and neck cancers. In this mini-review, we focus on the current progresses trying to unravel mechanisms of radiation-induced hair cell death and find out possible protection. P53, reactive oxygen species (ROS) and c-Jun N-terminal kinase (JNK) pathways have been proposed as pivotal in the processes leading to radiation hair cell death. Potential protectants, such as amifostine, N-acetylcysteine (NAC) and epicatechin (EC), are claimed to be effective at reducing radiation-inducedhair cell death. The RT dosage, selection and application of concurrent chemotherapy should be pre-examined in order to minimize the damage to cochlea hair cells.

Effects of Trimebutine Maleate on Colonic Motility through Ca^2+- activated K^+ Channels and L-type Ca^2+ Channels

Wei Tan,Hong Zhang,He-Sheng Luo,Hong Xia 대한약학회 2011 Archives of Pharmacal Research Vol.34 No.6

The effects of trimebutine maleate (TM) on spontaneous contractions of colonic longitudinal muscle were investigated in guinea pigs. The contractile responses of smooth muscle strips were recorded by an isometric force transducer. Membrane and action potentials were detected by an intracellular microelectrode technique. The whole-cell patch clamp recording technique was used to record the changes in large conductance Ca^2+-activated K^+ (BKca) and L-type Ca^2+ currents in colonic smooth muscle cells. At high concentrations (30, 100, and 300 μM), TM inhibited the amplitude of spontaneous contractions. At low concentrations (1 and 10 μM), TM attenuated the frequency and tone of smooth muscle strips, whereas TM had no influence on the amplitude of spontaneous contractions. TM depolarized the membrane potentials, but decreased the amplitude and frequency of action potentials at high concentrations. TM inhibited BKca and L-type Ca^2+ currents in a dose-dependent manner. In the presence of the BKca channel opener, NS1619, TM also inhibited BKca currents. Bayk8644, a L-type Ca^2+channel opener, increased L-type Ca^2+ currents. This augmentation was also attenuated by TM. These results suggest that TM attenuates intestinal motility through inhibition of L-type Ca^2+ currents, and depolarizes membrane potentials by reducing BKca currents. Thus, TM may be a multiple-ion channel regulator in the gastrointestinal tract.

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

Tan, Ru,Yao, Shu-Zhan,Huang, Zhao-Qin,Li, Jun,Li, Xin,Tan, Hai-Hua,Liu, Qing-Wei Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.18

Background: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophageal cancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distant lymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT and contrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophageal cancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCT scan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. The primary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed within one week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the gold standard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCT was conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and 221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT in detecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and 89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05). The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, as compared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with or without metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distant lymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity of FDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitive than MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophageal cancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detecting both regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value in distinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CT with MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.

Efficacy of perineural versus intravenous dexamethasone in prolonging the duration of analgesia when administered with peripheral nerve blocks: a systematic review and meta-analysis

Tan Elizabeth Sein Jieh,Tan Yan Ru,Liu Christopher Wei Yang 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.3

Background: Perineural dexamethasone has been regarded as a promising adjunct for prolonging the duration of nerve blocks. However, it is uncertain whether its effects are due to local effects on the nerves or from systemic absorption. This systematic review aimed to compare the duration of postoperative analgesia associated with perineural versus intravenous dexamethasone as an adjunct to peripheral nerve blocks. Methods: A total of 2,216 relevant academic articles were identified after a comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1967 until 2020. All randomized controlled trials that compared perineural and intravenous dexamethasone as adjuncts to peripheral nerve limb blocks were included.Results: Fifteen randomized controlled trials (1,467 cases; 738 perineural dexamethasone, 729 intravenous dexamethasone) were eligible. The primary outcome (duration of analgesia) was significantly longer in the perineural than in the intravenous dexamethasone group (mean difference [MD]: 2.72 h, 95% CI [1.42, 4.01], P < 0.001). Perineural dexamethasone was also found to prolong the sensory block (MD: 3.45 h, 95% CI [1.36, 5.54], P = 0.001) and lower 24 h postoperative pain scores (MD: −0.74 h, 95% CI [−1.40, −0.07], P = 0.03).Conclusions: This review confirms the greater efficacy of perineural compared to intravenous dexamethasone in prolonging the analgesic duration of peripheral nerve blocks. However, the extent of prolongation was small and may not represent a clinically meaningful difference.

Bioprospecting of Endophytic Fungi as Promising Anti-MRSA Agents

Wei, Yee-Min,Tan, Joo-Shun,Tang, Hock-Wei,Tong, Woei-Yenn,Leong, Chean-Ring,Tan, Wen-Nee The Korean Society of Pharmacognosy 2022 Natural Product Sciences Vol.28 No.3

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious threat to the global healthcare system. Ineffective and resistance to antibiotic treatments have increased morbidity and mortality rates worldwide. New and effective antibiotics are needed to combat against bacterial resistance. Endophytic fungi are crucial reservoirs of novel bioactive metabolites. In particular, the secondary metabolites show promising therapeutic potential, notably, antibacterial. This review discussed the emerging potential of endophytic fungi as anti-MRSA agents. The ecological sources of endophytic fungi were discussed with the synthesis of bioactive metabolites. The mode of antibacterial actions was elucidated to give a better understanding of the mechanisms involved. This review may serve as an important reference for future discovery and developments of anti-MRSA agents from endophytic fungi.